Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | D12575 | MN |
NPI | 1093047615 |
---|---|
Provider Name | Dr. Benjamin Ricks |
First Address | Saint Paul, MN 55114 |
Second Address | Minneapolis, MN 55455-0357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2010 |
Last Update Date | 07/02/2010 |